Saturday, November 19, 2011

False Intimacy

When I saw the name pop up on my schedule, I sighed deeply enough that the nurse and secretary both turned to stare. I ducked into my office. Mrs. Lange had just been double booked into my last opening of the day. I quickly perused my calender. The likelihood that I would make it on time to parent teacher conferences just plunged to zero.

Mrs. Lange was an old, crotchety, lady that belonged to my partner who was currently out of town. The cracks and crevices in her face formed chasms that only seem to deepen with each visit. Each clinical note began with same mirthful statement.

The patient is a ninety year old Caucasian female appearing older then her stated age.


As the day progressed, I felt a sense of dread in the pit of my stomach. Each visit with Mrs. Lange ended exactly the same. After a mind numbingly difficult history and physical, I would shoo her out of my office with a set of referrals and no likely explanations for her miriad symptoms.

Her testing always came back negative. By then her complaints were replaced by a new set of maladies.

And we danced this peculiar dance. Like fencers we sparred relentlessly. Each jab defended and countered in short order. Each match ending without the delivery of a fatal blow.

Mrs. Lange evoked in me the most difficult emotions as a doctor: anger, pity, frustration, and helplessness. She made me feel like a prisoner trapped behind the cold metal bars imposed by the exam room.

I left every appointment feeling beaten down and hopeless.


And this appointment was no different. I struggled through a dizzying list of nonsensical symptoms and signs. She spouted forth a complaint and I shot back an answer. Finally I convinced her to climb onto the examining table.

Her vital signs were normal. Her lungs and heart were regular. I lifted her sleeve to examine her elbow. My hands shook as I peered down at a patch of skin I hand never seen before.

Below her elbow, on her forearm, was a faded series of numbers. My heart fell into my abdomen as I realized that this was the branding of life's atrocities.

I must have been too hurried in the past to elicit a detailed social history.

She was a Holocaust survivor.


As physicans we suffer from false intimacy. We are given a pass to delve into the most delicate parts of people's lives. We see the best and worst of human nature.

But in reality, how well do we really know the innocents that sit before us? How often do we make snap decisions and judgements based on faulty and incomplete information?

Mrs. Lange taught me alot about making assumptions.

Every time I feel my temper rising and my patience ebbing I picture her ancient face.

And then I remember her arm.

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